Nursing-sensitive Indicators for Quality Improvement for Patients with Traumatic Brain Injury.

Context: Traumatic brain injury (TBI) can result in lifelong cognitive, emotional, and motor impairments. The emergency department is the first stop for diagnosing and treating patients with acute TBI, and the quality of nursing care can greatly influence the prognosis and progression of a patient's condition. Currently, standardized evaluation tools are lacking in the world for assessment of the quality of nursing care. Objective: The study intended to construct a nursing-sensitive indicator system for TBI patients, based on the scientific method of evidence-based nursing and the Delphi method, to provide a quantitative tool for emergency-nursing personnel to manage the quality of care for those patients. Design: Based on the Joanna Briggs Institute's evidence-based healthcare model, the research team performed a literature search and consulted reference guidelines, conducted two rounds of consultations with experts. sensitive indicators for quality of care, and constructed the sensitive indicator system. The team then conducted a retrospective study. Setting: The study took place in the department of emergency surgery at Shanxi Norman Bethune Hospital in Taiyuan, Shanxi, China. Participants: Participants were 56 patients with TBI who had been admitted to the emergency department between January 2022 and December 2022 and 44 patients with TBI who had been admitted to the emergency department between January 2023 and December 2023. Interventions: The research team assigned: (1) the 56 patients in the first group to the control group, who received routine nursing care and (2) the 44 patients in the second group to the intervention group, who received treatment using the sensitive indicator system for the quality of emergency care for TBI patients as well as routine care. Outcome Measures: In the verification study, the research team compared the group's rescue effects and satisfaction with emergency care. Results: In the first and second rounds of inquiries to experts, the research team distributed 25 questionnaires each time, with 25 valid questionnaires collected both times. The response rate for both rounds of inquiries was 100%. The expert authority coefficients for the first and second rounds of inquiries are 0.844 and 0.878, respectively. The sensitive indicator system's final construction included three primary indicators, seven secondary indicators, and 17 tertiary indicators. The AUC for the sensitive indicators was 0.8355882. The indicator system's use found that the intervention group had a shorter time to diagnosis (P < .001), emergency-department stay (P < .001), and emergency-department-to-surgery time (P < .001) compared to the control group. The intervention group also has a higher success rate for the emergency treatment (P = .014) and a higher nursing satisfaction with nurse-patient communications (P = .003), first-aid operations (P < .001), nursing attitudes (P < .001), and emergency environment (P < .001) compared to the control group. Conclusions: The process of constructing quality-sensitive indicators for the nursing care of TBI patients was scientific. The constructed quality-sensitive indicator system for the care of patients with TBI covers key factors that influence the quality of care. It's highly practical and has the ability to transform certain indicators, which can better guide the management of quality of care for TBI.

Analysis and Prediction of Urban Surface Transformation Based on Small Baseline Subset Interferometric Synthetic Aperture Radar and Sparrow Search Algorithm-Convolutional Neural Network-Long Short-Term Memory Model.

With the acceleration of urbanisation, urban areas are subject to the combined effects of the accumulation of various natural factors, such as changes in temperature leading to the thermal expansion or contraction of surface materials (rock, soil, etc.) and changes in precipitation and humidity leading to an increase in the self-weight of soil due to the infiltration of water along the cracks or pores in the ground. Therefore, the subsidence of urban areas has now become a serious geological disaster phenomenon. However, the use of traditional neural network prediction models has limitations when examining the causal relationships between time series surface deformation data and multiple influencing factors and when applying multiple influencing factors for predictive analyses. To this end, Sentinel-1A data from March 2017 to February 2023 were used as the data source in this paper, based on time series deformation data acquired using the small baseline subset interferometric synthetic aperture radar (SBAS-InSAR) technique. A sparrow search algorithm-convolutional neural network-long short-term memory (SSA-CNN-LSTM) neural network prediction model was built. The six factors of temperature, humidity, precipitation, and ground temperature at three different depths below the surface (5 cm, 10 cm, and 15 cm) were taken as the input of the model, and the surface deformation data were taken as the output of the neural network model. The correlation between the spatial and temporal evolution characteristics of the ground subsidence in urban areas and various influencing factors was analysed using grey correlation analysis, which proved that these six factors contribute to some extent to the deformation of the urban surface. The main urban area of Hohhot City, Inner Mongolia Autonomous Region, was used as the study area. In order to verify the efficacy of this neural network prediction model, the prediction effects of the multilayer perceptron (MLP), backpropagation (BP), and SSA-CNN-LSTM models were compared and analysed, with the values of the correlation coefficients of the feature points of A1, B1, and C1 being in the range of 0.92, 0.83, and 0.93, respectively. The results show that compared with the traditional MLP and BP neural network models, the SSA-CNN-LSTM model achieves a higher performance in predicting time series surface deformation data in urban areas, which provides new ideas and methods for this area of research.

Analysis of the distribution across media, migration, and related driving factors of fluoride in cold and arid lakes during the freezing period.

Fluoride pollution in water has become a global challenge. This challenge especially affects China as a country experiencing serious fluoride pollution. While the have been past studies on the spatial distribution of fluoride, there has been less attention on different forms of fluoride. This study collected 176 samples (60, 40, and 76 ice, water, and sediment samples, respectively) from Lake Ulansuhai during the freezing period. The occurrence and spatial distribution characteristics of fluoride in lake ice-water-sediment were explored using Kriging interpolation, Piper three-line diagram, and Gibbs diagram analysis methods. The migration and transformation of fluoride during the freezing period were revealed and the factors influencing fluoride concentration in the water body were discussed considering the hydrochemical characteristics of lake surface water. The results showed that the average fluoride concentrations in the upper ice, middle ice and lower ice were 0.18, 0.09, and 0.12 mg/L, respectively, decreasing from north to south in the lake. The average concentrations of fluoride in surface water and bottom water were 0.63 and 0.83 mg/L, respectively. The concentrations of fluoride in ice and water were within the World Health Organisation drinking water threshold of 1.50 mg/L and the Class III Chinese surface water standard (GB3838-2002). The average sediment total fluorine was 1344.38 ± 200 mg/kg, significantly exceeding the global average (321 mg/kg) and decreasing with depth. The contents of water soluble, exchangeable, Fe/Mn bound, organic bound, and residual fluorides were 40.22-47.18, 13.24-43.23, 49.52-160.48, and 71.59-173.03 mg/kg, respectively. There was a significant positive correlation between fluoride concentration in ice and that in water. The change in fluoride concentration in water was mainly due to specific climatic and geographical conditions, pH, hydrochemical characteristics and ice sealing. This study is of great significance for the management of high-fluorine lakes in arid and semi-arid areas.

Global, regional, and national burden of kidney dysfunction from 1990 to 2019: a systematic analysis from the global burden of disease study 2019.

OBJECTIVE: We aim to explore the prevalence and temporal trends of the burden of kidney dysfunction (KD) in global, regional and national level, since a lack of related studies. DESIGN: Cross-sectional study. MATERIALS: The data of this research was obtained from Global Burden of Diseases Study 2019. The estimation of the prevalence, which was measured by the summary exposure value (SEV), and attributable burden of KD was performed by DisMod-MR 2.1, a Bayesian meta-regression tool. The Spearman rank order correlation method was adopted to perform correlation analysis. The temporal trends were represented by the estimated annual percentage change (EAPC). RESULTS: In 2019, there were total 3.16 million deaths and 76.5 million disability-adjusted life years (DALYs) attributable to KD, increased by 101.1% and 81.7% compared with that in 1990, respectively. From 1990 to 2019, the prevalence of KD has increased in worldwide, but decreased in High-income Asia Pacific. Nearly 48.5% of countries globally, such as South Africa, Egypt and Mexico had increased mortality rates of KD from 1990 to 2019 while 44.6% for disability rate. Countries with lower socio-demographic index (SDI) are facing a higher prevalence as well as mortality and disability rate compared with those with higher SDI. Compared with females, the prevalence of KD was lower in males, however the attributable mortality and disability rate were higher in all years from 1990 to 2019. CONCLUSION: With the progress of senescent, we will face more severe challenges of reducing the prevalence and attributable burden of KD, especially in regions with lower SDI. Effective measures are urgently required to alleviate the prevalence and burden of KD.

Conversion of cellulose into levulinic acid under the catalysis of Brønsted acidic ionic liquid and erbium chloride in water.

We propose a new approach for the synergistically catalytic conversion of cellulose to levulinic acid (LA) in water by SO3H-functionalized ionic liquid (SFIL) and lanthanide chloride (LnCl3). Compared with using 1-methyl-3-(3-sulfopropyl)imidazolium chloride ([MIMPS]Cl) only, the LA yield using [MIMPS]Cl and ErCl3 increased by 14.4% and 13.6% at 50 mol% of IL and 30 mol% of IL, respectively. Moreover, the combined [MIMPS]Cl and ErCl3 system can tolerate high concentrations of substrates and maintain high activity at eleven runs. We also investigated the effects of the cation structure of ionic liquids (alkyl chain length, hydroxyl groups on the side chains, and aromatic properties) on LA production. The observations can provide useful information for designing efficient ionic liquid catalysts for biomass utilization.

[Clinical characteristics of critically ill pregnant women with different admission methods to intensive care unit: data analysis from 2006 to 2019 in the university hospital].

OBJECTIVE: To compare the clinical characteristics of critically ill pregnant women admitted to the intensive care unit (ICU) with different admission methods, in order to make more effective and rational use of ICU resources. METHODS: A retrospective study was conducted. The clinical data of critically ill pregnant women admitted to ICU of Peking University Third Hospital from January 2006 to July 2019 were analyzed. According to the admission mode to ICU, the pregnant women were divided into emergency admission group (transferred to ICU on the same day or the next day due to critical illness) and planned admission group (transferred to ICU 2 days after admitting in obstetric ward). The clinical characteristics of ICU critical pregnant women, such as the incidence, causes of admission, severity of the disease, main treatment measures, mortality, and medical expenses were collected, and a comparative analysis between the two groups was performed. RESULTS: During the nearly 14 years, a total of 576 critical pregnant women in ICU were enrolled, accounting for 0.8% (576/71 790) of the total number of obstetric inpatients and 4.6% (576/12 412) of the total number of ICU inpatients. Seven maternal deaths accounted for 1.2% of all critically pregnant women transferred to ICU, and the overall mortality of pregnant women was 10/100 thousand. Of the 576 critically pregnant women, there were 327 patients (56.8%) in the emergency admission group and 249 patients (43.2%) in the planned admission group. Compared with the planned admission group, the proportion of elective cesarean section in the emergency admission group was significantly lower (17.7% vs. 94.0%, P < 0.01), and the proportion of emergency cesarean section was significantly higher (65.1% vs. 2.4%, P < 0.01), the acute physiology and chronic health evaluation (APACHE II, APACHE III) scores, simplified acute physiology score II (SAPS II) and Marshall score were significantly higher [APACHE II score: 6.0 (4.0, 9.8) vs. 4.0 (3.0, 7.0), APACHE III score: 14.0 (11.0, 20.3) vs. 12.0 (9.0, 16.0), SAPS II score: 8 (0, 12) vs. 3 (0, 8), Marshall score: 2 (1, 4) vs. 1 (1, 3), all P < 0.01]. The length of ICU stay in the emergency admission group was significantly longer than that in the planned admission group [days: 2 (1, 5) vs. 2 (1, 3), P < 0.01], and the total length of hospital stay was significantly shorter [days: 9 (7, 13) vs. 13 (10, 18), P < 0.01]. Both in the emergency admission group and the planned admission group, obstetric factors were the main reason for admission, 60.9% (199/327) and 70.3% (175/249), respectively. The proportion of postpartum hemorrhage was the highest [35.2% (115/327) and 57.0% (142/249)], followed by preeclampsia/eclampsia [7.0% (23/327) and 7.6% (19/249)]. Only 7 of the 19 critically pregnant women with puerperal infection were planned admission. All 21 patients with acute fatty liver of pregnancy (AFLP) during pregnancy were emergency admission. Among the emergency and planned admission patients, 73 patients (22.3%) and 42 patients (16.9%) required mechanical ventilation (duration of mechanical ventilation > 24 hours), 99 patients (30.3%) and 35 patients (14.1%) needed vasoactive agents, 67 patients (20.5%) and 20 patients (8.0%) received hemodynamic monitoring, and 123 patients (37.6%) and 154 patients (61.8%) were given anticoagulation therapy, respectively. In terms of severity score of critical pregnant women, there were significant differences in APACHE II, APACHE III, SAPS II and Marshall scores of pregnant women with different diseases. Among them, the APACHE III, SAPS II and Marshall scores of AFLP were the highest [21.0 (15.0, 32.5), 12.0 (6.0, 16.5) and 6.0 (3.5, 8.0), respectively]. The APACHE II and APACHE III scores of postpartum hemorrhage were the lowest [4.0 (3.0, 7.0), 12.0 (10.0, 16.0)]. The SAPS II score of pneumonia was the lowest [2.0 (0, 14.0)]. The Marshall score for puerperal infection was the lowest [1.0 (0, 3.0)]. In terms of the total medical expenses, the cost in the emergency admission group was significantly lower than that in the planned admission group [10 thousand Yuan: 3.1 (2.0, 4.7) vs. 4.1 (2.9, 5.8), P < 0.05]. CONCLUSIONS: Compared with the critically ill pregnant women who planned to be admitted to ICU, the patients emergency admitted to ICU were more complicated and urgent, and the severity of the condition was scored higher. At present, the severity scoring system commonly used in ICU can only partly evaluate the severity of critically ill pregnant women, therefore, it is necessary to design the specific severity scoring system for critically ill pregnant women to effectively and rationally use the precious ICU resources.

MiR-181b-5p modulates chemosensitivity of glioma cells to temozolomide by targeting Bcl-2.

Chemotherapy is the main postsurgical and adjuvant therapy for glioma, and intrinsic or acquired temozolomide (TMZ) resistance may result in poor prognosis. The miR-181 family was discovered to play an important role in regulating biological functions in glioma, and miR-181b is less expressed in human gliomas as a tumor-suppressive miRNA. The aim of this study was to explore the molecular mechanism of miR-181b-5p and its target gene on modulating TMZ chemosensitivity in glioma cells. The enhanced chemosensitivity effect of miR-181b-5p to TMZ in glioma cells U87MG and U251 was detected by MTT method. Dual luciferase reporter assay, quantitative real-time PCR (qRT-PCR) and Western blotting were performed to demonstrate that miR-181b-5p directly targets Bcl-2 to reduce the expression. Transwell and flow cytometry assays showed that combination of miR-181b-5p and TMZ exerted stronger effects on inhibiting U87MG cells proliferation, migration and invasion as well as promoting apoptosis and S phase arrest than miR-181b-5p and TMZ alone. The same tendency was observed in the upregulation of apoptosis-related protein Bax and downregulation of cycle-related proteins CyclinD1 and CDK4. In vivo experiments indicated that miR-181b-5p could enhance the tumor-suppressive effect of TMZ. In conclusion, our findings indicate that upregulation of miR-181b-5p targets Bcl-2 directly and may function as an important modifier to sensitize glioma cells to TMZ.

In vivo evaluation of an antibacterial coating containing halogenated furanone compound-loaded poly(l-lactic acid) nanoparticles on microarc-oxidized titanium implants.

To prevent peri-implant infection, a new antibacterial coating containing a halogenated furanone compound, (Z-)-4-bromo-5-(bromomethylene)-2(5H)-furanone-loaded poly(l-lactic acid) nanoparticles, has been fabricated. The current study was designed to evaluate the preventive effect of the antibacterial coating under a simulated environment of peri-implant infection in vivo. Microarc-oxidized titanium implants treated with minocycline hydrochloride ointment were used as positive control group, and microarc-oxidized titanium implants without any treatment were used as blank control group. Three kinds of implants were implanted in dogs' mandibles, and the peri-implant infection was simulated by silk ligation and feeding high sugar diet. After 2-month implantation, the results showed that no significant differences were detected between the experimental and positive control groups (P>0.05), but the data of clinical measurements of the blank control group were significantly higher than those of the other two groups (P<0.05), and the bone-implant contact rate and ultimate interfacial strength were significantly lower than those of the other two groups (P<0.05). Scanning electron microscope observation and histological examination showed that more new bone was formed on the surface of the experimental and positive control groups. It can be concluded that the antibacterial coating fabricated on implants has remarkable preventive effect on peri-implant infection at the early stage.

Antibacterial activity and biological performance of a novel antibacterial coating containing a halogenated furanone compound loaded poly(L-lactic acid) nanoparticles on microarc-oxidized titanium.

Titanium implants have been widely used for many medical applications, but bacterial infection after implant surgery remains one of the most common and intractable complications. To this end, long-term antibacterial ability of the implant surface is highly desirable to prevent implant-associated infection. In this study, a novel antibacterial coating containing a new antibacterial agent, (Z-)-4-bromo-5-(bromomethylene)-2(5H)-furanone loaded poly(L-lactic acid) nanoparticles, was fabricated on microarc-oxidized titanium for this purpose. The antibacterial coating produced a unique inhibition zone against Staphylococcus aureus throughout a 60-day study period, which is normally long enough to prevent the infection around implants in the early and intermediate stages. The antibacterial rate for adherent S. aureus was about 100% in the first 10 days and constantly remained over 90% in the following 20 days. Fluorescence staining of adherent S. aureus also confirmed the excellent antibacterial ability of the antibacterial coating. Moreover, in vitro experiments showed an enhanced osteoblast adhesion and proliferation on the antibacterial coating, and more notable cell spread was observed at the early stage. It is therefore concluded that the fabricated antibacterial coating, which exhibits relatively long-term antibacterial ability and excellent biological performance, is a potential and promising strategy to prevent implant-associated infection.

Selective and recyclable depolymerization of cellulose to levulinic acid catalyzed by acidic ionic liquid.

Cellulose depolymerization to levulinic acid (LA) was catalyzed by acidic ionic liquids (ILs) selectively and recyclably under hydrothermal conditions. The effects of reaction temperature, time, water amount and cellulose intake were investigated. Dilution effect becomes more pronounced at lower cellulose intake, dramatically improving the yield of LA to 86.1%. A kinetic model has been developed based on experimental data, whereby a good fit was obtained and kinetic parameters were derived. The relationships between IL structure, polymeric structure and depolymerization efficiency were established, shedding light on the in-depth catalytic mechanism of IL, inclusive of acidity and hydrogen bonding ability. The LA product can be readily separated through extraction by methyl isobutyl ketone (MIBK) and IL can be reused over five cycles without loss of activity. This environmentally friendly methodology can be applied to selective production of LA from versatile biomass feedstocks, including cellulose and derivatives, glucose, fructose and HMF.

Selective conversion of cellulose to levulinic acid via microwave-assisted synthesis in ionic liquids.

A highly selective approach to produce levulinic acid from cellulose was developed via microwave-assisted synthesis in SO3H-functionalized ionic liquids (SFILs). The effects of reaction conditions and ionic liquid structures on the yield of levulinic acid have been investigated, where the highest yield of 55.0% was obtained. The catalytic activities of SFILs depend on the anions and decrease in the order: HSO4->CH3SO3->H2PO4-, which is in good agreement with their acidity order. The SFILs are efficient catalysts for cellulose conversion into levulinic acid and the subsequent esterification, which facilitates the separation of product and reuse of ionic liquids.

Fabrication and in vitro release behavior of a novel antibacterial coating containing halogenated furanone-loaded poly(L-lactic acid) nanoparticles on microarc-oxidized titanium.

BACKGROUND: Dental implants have become increasingly common for the management of missing teeth. However, peri-implant infection remains a problem, is usually difficult to treat, and may lead eventually to dental implant failure. The aim of this study was to fabricate a novel antibacterial coating containing a halogenated furanone compound, ie, (Z-)-4-bromo-5-(bromomethylene)-2(5H)-furanone (BBF)-loaded poly(L-lactic acid) (PLLA) nanoparticles on microarc-oxidized titanium and to evaluate its release behavior in vitro. METHODS: BBF-loaded PLLA nanoparticles were prepared using the emulsion solvent-evaporation method, and the antibacterial coating was fabricated by cross-linking BBF-loaded PLLA nanoparticles with gelatin on microarc-oxidized titanium. RESULTS: The BBF-loaded PLLA nanoparticles had a small particle size (408 ± 14 nm), a low polydispersity index (0.140 ± 0.008), a high encapsulation efficiency (72.44% ± 1.27%), and a fine spherical shape with a smooth surface. The morphology of the fabricated antibacterial coating showed that the BBF-loaded PLLA nanoparticles were well distributed in the pores of the microarc oxidation coating, and were cross-linked with each other and the wall pores by gelatin. The release study indicated that the antibacterial coating could achieve sustained release of BBF for 60 days, with a slight initial burst release during the first 4 hours. CONCLUSION: The novel antibacterial coating fabricated in this study is a potentially promising method for prevention of early peri-implant infection.